Promoting Culture Change with the Arch Collaborative

Most healthcare leaders have already found that their organizations have problems. Learning specific details about those problems and the deciding how to tackle them is more difficult to do. For Northwestern Memorial Health Care, participating in the Arch Collaborative has sent us in the right direction.

The lessons gleaned from the Collaborative have guided or validated several of our organization’s efforts to improve our overall culture.

Comparing even our recent past with the status quo is proof that a few key insights, when thoughtfully acted upon, can make an impressive difference.

Then:
Our clinicians received varied amounts of training, depending on which EMR they used.

Now:
We use a centralized structure to provide ongoing support and education to all providers.

At the time we participated in the Arch Collaborative survey, our organization was using two EMRs: Cerner’s and Epic’s. The Cerner users didn’t receive much training at all. On the other hand, we were heavily invested in providing training and support to the Epic users.

Our survey results made it quite clear: the clinicians receiving ongoing support were happier. Those clinicians expressed that they felt more comfortable using the EMR and that they had more control over their environment.

We realized that what doctors really want is for support resources to show up at the elbow, steer the doctors through efficiency boosters, and provide help when changes are made to the EMR.

Today, one of our biggest focuses is to scale our support services. With a centralized support structure, we are now learning how to meet the local campus needs with limited resources from the central training team but local support from physician superusers.

We hope this will help our clinicians make positive changes, create good habits, and become more effective EMR users.

Then:
We spent our resources trying to fix the most annoying things in our EMRs.

Now:
We take the time to learn which changes will be most valuable to our clinicians.

Dealing with problems in the EMR is a necessity in every provider organization. But modifying the things that got the most complaints wasn’t always a helpful approach for us.

A lot of the EMR-improvement projects our IT team worked on were for specific physicians or physician groups, and non-physicians sometimes got the short end of the stick.

The Arch Collaborative showed us the value of assessing the user experience with the EMR. We also realized that we needed to make the EMR highly usable for each individual, not just the physicians.

Before making decisions about EMR improvements, we now strive to understand the work that our clinicians and physicians do on a daily basis.

We are confident that by making the most heavily used EMR functions easier for our employees, we will increase EMR satisfaction throughout our organization.

Then:
The IT team was blamed when requested EMR improvements came slowly or not at all.

Now:
Clinical leaders prioritize requests and communicate about which ones will be completed.

In the past, our IT team chose which improvement requests to work on. They hated telling our physicians “No,” so they didn’t—they just put every item on the list and said they’d get to it “eventually.” Sometimes “eventually” turned into “never.”

Our physicians didn’t know which of their requests would actually be granted. They seemed to think, “Maybe if I yell loudly and often enough, someone will choose my problem to work on.” The results were a lot of noise and frustration on both sides of the process.

In our new setup, the prioritization of EMR change requests is done in groups that we call collaboratives. Each collaborative includes leaders from the academic, clinical, and community sides.

They decide which suggested EMR improvements would meet global needs or add the most to our care quality, revenue, efficiency, or patient safety.

The collaboratives also share with our clinicians the reasoning behind their decisions. Now our physicians know that if they follow the change management process, someone will think critically about their change requests.

When a request gets turned down, at least the physician has closure. Because of this, our physicians are now more eager to take their best ideas to the collaboratives.

Now:
We are hard at work implementing ideas from the Arch Collaborative to boost our culture.

Soon:
We hope further participation in the Arch Collaborative will show us more ways to improve.

The experiences we’ve had thus far with the Arch Collaborative make us excited to learn even more from our fellow Collaborative members and our own employees. In our next Collaborative survey, we plan to add our nurses to the list of participants.

We’re also eager to see exactly how much our cultural changes have affected our employees and their satisfaction with the EMR.

I’m grateful that we decided to find out how our providers felt about our core systems. Because we and over 130 other organizations measured the usability of our EMRs and the governance surrounding them, all of us can benefit and make meaningful progress toward better healthcare.